The Trapped Woman.
NATIONAL JOURNAL OF HOMOEOPATHY 1995 Mar / Apr Vol IV No 2.
Dhawale Kumar.
Cases.
` Nat-m.

Neurosis is a later reflection of an arrested development in childhood. One pays, at leisure, for unresolved childhood difficulties, the payment calculated at compound interest. The payment, though heavy, is preferred to the alternative of freedom from the neurotic bondage which carries a heavier price tag - it demands an inner change. The nucleus of neurosis has got fossilized in childhood, thus rendering all change a threat to be avoided at all costs. Thus arises the neurotic paradox - starvation amidst plenty.

The Homoeopathic physician, a specialist in chronic disease, needs to undertake a thorough study of his chronic patients, since a number of them are likely to be harbouring a neurotic paradox.

Let us examine an interesting experience where the patient submitted a write-up of her complaints on a standardized format of History direction sheet.

History as written by the patient:

Mrs. A.M. Birth - 7-11-65. Female. Married since October 1988. Hindu, Vaishnav, Vegetarian, takes eggs once in a way in cakes.
Habituated to tea and coffee - 4 - 6 cups daily.
A.B.A., in literature and journalism. She is currently a freelance journalist for a number of daily papers.
Joint Family set-up - Father-in-law and his second wife, (my husbands mother was murdered 41-2 years ago) my brother-in-law, his wife and us. While I maintain fairly harmonious relationship with father and mother-in-law, there is no communication with my brother-in-law, his wife and us. Ironically, my brother-in-law was very close to me till his marriage.

My husband dislikes his father and talks to him only occasionally. He in turn, dislikes his second sons wife (a Punjabi; so the marriage was not entirely to his liking) and refuses to talk to her. In this fine set up, the atmosphere is one of tension, unspoken dislike and extreme irritation.

Personally, I feel I have an unfair deal, as my sister-in-law usually gets away with murder. There is a tendency in our household to maintain "outward peace" at all costs for the sake of my brother-in-law, on whom rests the onus of looking after the family business.

"My husband has not really contributed to the house-hold expenses, which is the root of all our problems".

"I planned to migrate to the US. I got there, but my husband didnt get his visa and so I had to come back. That is a festering wound too".

"My father-in-law is an extremely shrewd businessman, (a little batty, though) aged 52. He remarried his wifes sister a few months after our marriage. She is 48 and without her wed probably be in a bigger mess. My brother-in-law and his wife are both 28 and display the IQ of a 10 years old - they are constantly talking of "Sides".

"My husband has a sister who is married and lives in Madras. My husbands mother died in 87. My sister-in-law claims to do something in computers but as of now is in permanent respite, blissfully fat, at home with her child. My husbands sister is currently expecting a child and hence there is this unstated pressure on me to produce one too!".

"My daily routine is quite unplanned. Work suddenly crops up and my entire schedule has to be reworked. My mother-in-law cooks in the mornings while the two of us (i.e. the daughter-in-law) are supposed to split evenings. However, inevitably it is always my mother-in-law and I who end up doing the evenings. Oh well! I take a walk after dinner, which is my main meal".

Diet : Tea and toast, khakra and curds or a sandwich for lunch; if at home, tea, coffee, then dinner.

1. Since marriage I have earned my own money, at least for my personal needs, etc. My husband used to borrow from me. He has been doing psycho-analysis and is often short. We really contribute only Rs. 2000 towards the house hold monthly expenses which amount to Rs. 16,000/- or so.!.
   
   There are plans to separate suffice to say I dislike this house and most of the people in it; my conversation is restricted to my mother-in-law (all the inanities of a domestic set up etc) and my husband.
2. I have been unable to save; I owe my father money, as he helped finance my trip abroad. Socially, since my husband and I both get bored easily, we dont have a great time. Most often our sojourns with Couple friends end in depressing conversations on how destructive marriage really is and how it is so easy to have an affair.

CHIEF COMPLAINTS:

I am becoming a major grouse! I really am, come to think it; but mercifully, my sense if humour remains!.

I have this noise problem, diagnosed as tinnitus. Even the TV which is played at a really loud level at our house, irritates me. The cranking of the wheels; the cries of hawkers in local trains, my husband and one of our couple friends loud conversations, my nephew wailing etc! The area that is affected is my head. I feel a withdrawing and a sort of spasm takes place and I feel the noise is going to engulf me. Following my return from USA in September, I was unable to even go out, so loud seemed the surrounding noises. Emotionally too I was undergoing a traumatic time as I had come back without going to school-something I had wanted to do very much. I just thought my marriage wouldnt last through a long separation, so I came back.

I feel lethargic, exhausted, cut up and contemptuous towards my sister-in-law. Relief is found in going away from here. I do sweat a lot at those times.

Since the past three months I have this cold and cough that keeps persisting. It is I think, a reaction to the pollution around.

I had this skin problem - lichen planus, psoriasis, around the ankles and feet and which reduced after treatment by a skin specialist which included localized cortisone injections. I find it surfacing again.

Other Complaints:

I have problems with my teeth - 3 root canals, also hair fall and a slight skin problem, especially on the chin and lower back.

Personal Data:

I am 53 kgs in weight, medium height with short hair.

I am emotionally over wrought, too sensitive over futile issues. I would like to attain a better standard of writing and be able to paint. For my age and experience, I have got recognition, thought not monetary gains. I have turned bitter after marriage. I view people unfairly and feel let down. But I still have few friends with whom I have fun. I am attached to my father and brothers even though they are busy. I feel sorry for my mother due to her obesity-related problem and agoraphobia.

As for my responsibilities I feel I have been thrust into a no -go situation.

Food - prefer salty, varied mustards, Italian spices and pastas. Dislike oily, spicy things like pav-bhaji and sambhar, and Gujarati food.

I prefer monsoons, dislike sun or too cold a climate. I bathe twice a day, and listen to music or read. Sleep is disturbed and of late I dont remember too many dreams only garbled images.

Sex - I had an MTP a week before my marriage though ironically we had not slept together in the sense of consummation. I had sex a few months after we were married as it was extremely painful earlier. I took triquilar tablets for nearly two years. We have regular sex unless my husband is going through his occasional tense states. However, its still painful. My periods are regular.

Previous illness: Nothing major.

Parental Data: My father is 52, very stressed. Has a hearing problem, indigestion and suffers from high blood cholesterol levels. He suffered one stroke years ago. My mother is 50, overweight, neurotic, high BP patient, hasnt been out of the house for years. My elder brother is 32, married with 2 kids. We dont have too much to talk about. My second brother is 31, unmarried, lives with my parents, hates the house, is very keyed and restless. He pretends that his main priority in life is money. Hes someone I like, as also my husband though we spend a lot of time arguing over basic issues.

DOCUMENT ANALYSIS

1. What are the complaints?
   
   No significant physical chief complaint except a "noise problem" tinnitus, a blocking feeling in the ears; a feeling of noise is going to engulf me; a withdrawing and sort of spasm. She gives a vivid description of her current emotional state lethargic exhausted, cut-up and contemptuous.
   
   Other physical complaints is recurrent colds, skin eruptions and hair fall.
2. What is the suffering?
   
   A sensitive perusal of the inter-personal dynamics (which is describes as a fine set-up) would give the following representation. "Thrust in a no - go situation is not surprising. But surely, this state of affairs has not always been present. It has evolved through contribution from all members.
3. When do these complaints emerge?
   
   The modalities of the chief complaint form an impressive list not to be located in any repertory. These are -Aggravated - after loud volume of a TV, cranking wheels, hawkers cries, nephew wailing, after return from USA and was better in the USA.
   
   It is clear from the above that the patient prefers vast spaces and silences which are endemic to the United States. Living in cosmopolitan Bombay and in an equally cosmopolitan family aggravates her neurosis.
4. How did the suffering originate?
   
   Personality patterns (and dysfunctions) have their origin in childhood. The significant family members - the parents, the grandparents, the siblings - determine the social give-and-take which we imbibe in our behavior and subsequently build upon. The following representation would make it clear.

The patient has been close to the father and to the younger brother - both of whom are sufficiently stressed individuals. The father has a hearing difficulty and digestion problem, the brother lives behind a facade which our patient sees through and perhaps sympathizes with. Her mother is a confirmed neurotic not having left the house for years!.

One finds it hard to believe that our patient had a happy childhood under such conditions. She is clearly overly emotional and hyper sensitive. Having suffered a deep disappointment at some place + time, she has become resentful and bitter and aggravated by human + husband contact (Aggr coition).

THE CLINICAL INTERVIEW:

In case of the written document was not reflected in the oral communication indicating that inter-personal encounters were indeed stressful. She was fighting back fears which threatened to drown her at many junctures. The physician needs to be silent and non-judgmental to enable the entire story to emerge.

LIFE SPACE:

Patient comes from a fairly well-to-do family. The grandfather had started a cloth mill which the father and his brother have been managing. But now the cloth mill crisis worried the father worried. The brothers have diverted into other avenues. The father, though, retains a certain amount of respect in the society and is an important trustee of a large Temple Trust.

The mother has not been able to adjust with the joint family and has developed paranoid symptoms directed against the mother-in-law. She is under psycho-analysis since years. She attributes her problem of obesity to the birth of the patient and has always held it against her. She used to scream and shout at the patient which probably resulted in sensitivity to noise.

The patient was an average student but was interested in her extra-curricular activities and was a house-captain every year. Arts was her interest and she wished to pursue it abroad but her father opposed and so she joined the Arts faculty of a local College. While she studied Literature she came across a boy studying Economics from a rich Textile family. They decided to marry much to the disapproval of her family who felt that she deserved a better boy.

After B.A. she did a course in Journalism since quite a few of her articles were accepted in the daily newspapers and Journals. She made this her career. In the meantime, her fiance decided on computers but was as yet unsettled when tragedy befell; his mother was murdered during a theft in the house. This was a great shock to the family. The marriage was preponed. Just prior to marriage, she had missed her period and to her great shock, the gynaecologist confirmed her pregnancy. She was bemused since to the best of her knowledge the relationship was not consummated. She went in for an MTP which led her to dyspareunia which persists to date.

A few months after this marriage, the Father-in-law remarried his deceased wifes sister who was a spinster. Shortly her brother-in-law married a Punjabi girl - another shock! Tension in the house increased and so did her complaints.

To get out she went to USA after persuading her father to sponsor her trip. There she found peace. The vast distance between habitation helped the ear condition. She was accepted by a University for a course in Graphics. But the husband was denied a visa and she faced the prospect of remaining alone for three years. She called up her husband and asked his advice. He agreed to let her study. However, she detected a wavering in his voice. She realized that if she was to stay abroad for three years, the relationship would not last. This acute realization resulted in her return without even starting what she was wanted to do! The complaints recurred on entering Bombay.

Uncertainty surrounds her. Strife is all around. She herself contributes to it. Her husband does not earn. She feels guilty. She has undergone psychoanalysis and that has allowed her to get a certain view of herself but has not lessened her suffering. She could communicate all this with difficulty fighting back her tears.

The auditory system could take it no more than when as a child she faced a frustrated mother who poured out her resentment at her very existence in words - loud and clear. The minds hypersensitivity at being intruded upon was combined with a self-image derived from maternal rejection which was negative and thus the isolationist position grew upon her. Little wonder then that the freedom gained in the States proved to be costly since it made her conscious of her utter inner loneliness in a vast continent. Hence she had to return to her marriage, her home, her no - go situation and to her neurosis!.

RESOLUTION:

Nat-mur helped her to an extent. She conceived and delivered a girl child. She went into post-partum depression and needed Pulsatilla. The noise problem considerably reduced (inspite of having a fairly noisy child!) The skin allergy settled down. What stubbornly refused to respond was her allergic cough. Various acute medicines were tried without effect. An observation was that the cough, however distressing at home, was rarely heard in the clinic. She did not take too kindly to this observation. But the neurosis was rekindled when her complaint about the brother-in-law being cruel to her child was questioned. She took offence and wrote a long letter stating that she found herself unable to continue with her treatment since the wavelengths differed and the physician was no longer taking her seriously. Treatment continued for her daughter and about four months later she once again resumed her treatment. On affirmation she left a note which stated that the real reason for terminating treatment was her discomfort at having developed a crush on the physician. The only solution at that time was to keep away till she was in a position to handle it in a better way.

CONCLUSION:

A neurosis results from an unexpressed and unresolved problem of childhood. The adult world beckons the individual to grow out of this neurosis. These pressures produce a patient a therapeutic encounter is inevitable.

Here the patient reacted to the noise of her traumatic childhood by blocking out inputs from her mother and in adulthood she helplessly adopted the same posture. This proved maladaptive in the long run since it restricted her potentialities to feel fully and communicate meaningfully so essential for the art and journalism that was her profession.

The therapy helped her to open up and her neurosis reduced. But that brought to the surface an entirely different problem a problem that only a Natrum-mur can create. It is an indication of the ability of a therapeutic relationship to grow under the benign influence of Natrum-mur that the block of love relationship too was overcome without compromising the potentialities. (feeling and communicating).

A Homoeopathic physician always faces an occupational hazard in his encounter with Neurosis. Professional discipline when practised with due sensitivity protects him and patients from these hazards. The similimum, under these conditions, performs miracles not hitherto dreamt of.